An accident date is required for Federal program when an accident related diagnosis is present.
What this means: Some claims to this payer may reject for 'An accident date is required for Federal program when an accident related diagnosis is present.'
Provider action: Check the codes on the claims, are they considered accident codes? If so you will need to submit an accident indicator and and accident date on your claim.
Rejection Removal: Rejections will not be removed by Gateway EDI as they are valid.
Re-filing: Once this is corrected, you would want to re-file any claims that rejected for this reason.
An invalid code value was encountered. Element PAT01 (Individual Relationship Code) does not contain
What this means: Claims to this payer may reject for 'An invalid code value was encountered. Element PAT01 (Individual Relationship Code) does not contain a [OTER].'
Provider action: Verify that you are not sending the same insured and patient name on the claims, if so correct and resubmit.
Rejection Removal: Rejections will not be removed by Gateway EDI as they are valid.
Re-filing: Once this is corrected, you would want to re-file any
RENDERING PHYSICIAN IS REQUIRED
What this means: There are two possible reasons for this
rejection:
1. If the provider sends the claim with only the individual NPI in the billing loop and they are credentialed with a group NPI, then the claims will be rejected by the payer.
2. If the provider sends the claim with only the individual NPI in the billing loop and the entity type qualifier is 2 (non-person), then the claims will be rejected by the payer.
Resubmit with Group NPI (Box 33) information.
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
Here is the big list of Medical terminology abbreviation @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial ...
-
procedure code and description 71250 - Ct thorax w/o dye - average fee payment - $180 - $190 71275 CTA chest (noncoronary) 71260 CT ...
-
Emergency Ambulance Services Medicare will cover emergency ambulance services when the services are medically necessary, meet the desti...
-
procedure code and description 11042 -Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm o...
-
REIMBURSEMENT CODES FOR BONE DENSITOMETRY The new Balanced Budget Amendment, signed into law, mandates preventative care for high risk in...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion di...
-
Procedure code and description 72148 - MRI lumbar spine w/o dye - average fee payment - $230 - $240 72141 - Mri neck spine w/o dye -...
-
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
-
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
procedure code and description 78452 - Ht muscle image spect mult - average fee payment - $500 - $510 78451 Myocardial perfusion SPEC...
No comments:
Post a Comment